The Peer Healing Space Pathways Expression of Interest Form

INTRODUCTION

The Peer Healing Space 

The Peer Healing Space is a lived experience residential service for people who are experiencing distress or mental health challenges.  

It is a free mental health service that provides short-term care and support in a home-like setting for people aged 18 years or older. People can stay at the service for a few days or up to three weeks. It is run by people with lived and living experience of mental health challenges.  

This service is run by peer workers – people with lived experience of mental health challenges. It provides another alternative to hospital.  

The Peer Healing Space is located in Geelong. It has gardens, shared indoor spaces, and room to rest, connect, and heal in your own way.  

A stay at the service is your choice. You do not have to stay if you do not want to and you can leave at any time. There are no uniforms, no locked doors, and no forced treatment. 

You will still be able to access any support you are currently receiving. Planned visits from support staff are welcome. 

What guests can expect  

Support from peer workers with lived experience  
One-to-one support  
Group activities to help you connect with others  
Shared meals and outings in the community  
Support when you are feeling distressed  
Your own bedroom and private bathroom

What we ask from guests  

Work with us to help keep the space safe  
Tell us when you’re coming and going  
Follow the mutuality agreement  
Do not bring alcohol or other drugs on site  
Manage your own medications (if needed)

How The Peer Healing Space is different 

This service is run by peer workers – people with lived experience of mental health challenges. It provides another alternative to hospital.  

You are encouraged to stay connected with existing supports if you have them, and planned visits are welcome between 10am – 8pm to help with this. 

Any support you require with medication will need to be organised through external supports, Peer Mental Health workers do not manage medication, however there is a safe in your bedroom for storage of any medications that you take. 

We don't have AOD specialists on site, so if alcohol or drugs are part of your experience, we will talk about what a stay with us might look like. For this reason, we expect that no alcohol or other drugs will be brought or consumed on site, this is to help make the space safe enough for everyone. 

Interested?  

If this feels like something you are interested in, please complete the referral form so we can get to know you and your support needs a bit better. 

For more information on our community agreement, alcohol and other drugs approach, or medication approach, please read the documents available here.

Your responses will be

used to help improve our services so we can support people better, and  
combined (without identifying you) with responses from other people to understand how well we are supporting people
to help tailor supports to your individual needs, such as offering to be linked in with our Equity and Cultural Wellbeing Coordinator.

Who will see these 

Reports created from this information will not identify you and will be kept within Privacy and Confidentiality laws.

The Peer Healing Space Pathways Expression of Interest Form - Eligibility

Are you 18 years or older? *

YesNo

The Peer Healing Space is only available for those 18 years or above.

If you answered no to this question, unfortunately you’re not eligible for this service at this point in time. If you have any questions, please contact us on: thepeerhealingspace@mindaustralia.org.au

Are you located in Victoria? *

YesNo

The Peer Healing Space is a Victorian service and unable to support those interstate.

What can acute mental health distress look like?

People who use our service generally experience types of mental health distress which means that staying at home or in community is unmanageable (e.g. suicidality, altered realities, self-harm, psychosis, deep anxiety and depression)

The three areas our service is hoping to support:

People in acute distress who have been harmed by current system
People from communities or identities who are underserved by current mainstream system
People who are seeking peer led alternatives

Are you experiencing acute mental health distress? *

YesNo

The Peer Healing space is an alternative option to an acute mainstream mental health service.

Can you safely abstain from using drugs and alcohol during your stay? *

YesNo

The Peer Healing Space is a dry site that can’t safely support those detoxing from substances.

The Peer Healing Space Pathways Expression of Interest Form - Referral Details

Today's Date

Are you filling this out for yourself or someone else? *

MyselfFamily/carerProfessional

First Name of Referrer *

Last Name of Referrer *

Phone number of referrer *

Relation to the person *

Organisation *

Email of Referrer *

Consent

I understand that by submitting this information, I am consenting to Mind Australia’s Peer Healing Space staff contacting me by the phone number and/or email provided.
The phone number that calls you will be: 0456 537 421 *

Further information will be gathered on the next page, contact will only be made once this form is completed.

I understand that my information will be recorded in line with Mind’s Privacy, Confidentiality, and Consent policies. *

I understand my rights and responsibilities as a potential guest will be discussed with me as part of the referral process.
(Click here to view the consent form) *

The Peer Healing Space Pathways Expression of Interest Form - Personal Information

Preferred First Name *

Preferred Last Name *

Date of Birth *

Phone number *

Can we call this number?

YesNo

Can we text this number?

YesNo

Can we leave a voice message?

YesNo

Is there anything you'd like us to know about contacting you?For example, do you have preferred days or times? Would you like a text message first? Are there any safety considerations? Would you like us to contact you via another person, like your referrer?

Residential Address (if you have one)

Street address

City

State

Postcode

My mailing address is the same as my residential address

Mailing Address

Street address

City

State

Postcode

The below questions are being asked to ensure our service remains as safe and equitable as possible.

Would you like to be linked in with our Equity and Cultural Wellbeing Coordinator?

YesNo

Pronouns

I identify my gender as:

I identify as LGBTQIASB+

YesNoPrefer not to answer

Do you identify as Aboriginal and/or Torres Strait Islander?

Do you identify as an Asylum Seeker or Refugee?

YesNo

Are there any other identities, communities or cultures you belong to that are important for you to advise us on?

What language do you speak at home?

Is an interpreter required/preferred?

YesNo

How did you hear about our service?

Do you have any accessibility needs or things we should know that would facilitate your engagement with us?

Are you currently experiencing housing insecurity or homelessness?

YesNo

If so, are you engaged with any housing support services?

YesNo

In the event of an emergency, who is the main person we can contact on your behalf?

Emergency contact First Name

Emergency contact Last Name

Emergency contact phone number

Is there anything further we should know about this contact, e.g. what to disclose/not disclose to them?

service

location

Type of Referral

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